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Doran's Shield. HP, armor, hp regen. Can't beat it for lane with rammus.
Giant's Belt. Without HP, annie can tank better than you.
Boots 1 (or boots one after shield if it matters in your lane, often it doesn't since you have powerball).
Then sunfire. That's for farming, dps, health, armor.
then aegis. That's for MR, health, armor, and for your LAME SOLO QUEUE TEAM that never ever gets defensive gear, and certainly never armor or MR.

After that, counter items. GA is good but be careful investing that much without having a slab of health first. Also keep in mind if you initiate with PB you cannot immediately DBC, plan accordingly.

Early game should be easy with ram if you have anyone with range harass in your lane (full range not even necessary) Powerball them right off, auto-attack too if they aren't punishing you back. Clear aggro, repeat again, hit both if you can, + 1 auto-attack is good. Hopefully your lanemate adds to it. Either you now dominate (stay on caster mobs to zone them), or you health pot, and at level 3 (PB, taunt, taunt, dbc skill order, then ult/taunt/dbc/pb), you try to taunt/kill the weakest combined with summoner if you have one or two (exhaust, ignite).

You should not have to B until giant's belt, or after you kill one of them. If you do have to B, just buy one health pot, don't delay your GB.

At the worst, that should have them low also, either burns their HP pots or they also have to recall. Worst you should do is break even. Obviously if they are really good, a duo, or you have no range harass, it could be rough. But rammus tower hugging is great due to taunt/dbc, so even then you're in good shape compared to a lot of other champs vulnerable to tower dives.

Problem w/ sheild is that it doesn't build in to anything. This is an important concept with rammus as we will be money starved for most of the game.

I'm not sure I believe you play rammus much if you believe rammus with is "money starved most of the game". Especially with a sunfire as the first item. This isn't alistar.

#1 If he's being outharassed early game (he is), and blue pilling early, he is:
- missing out on minon gold
- missing out on gank potential in lane, and then snowball to another lane (mid)
- missing out on XP
- likewise his lanemate is similarly screwed, and his opponents are similarly gifted with free farming.

That alone makes staying in lane and surviving harass pay for itself 10 times over, especially if you land the gank or entirely out-zone them.

#2 Rammus will have an absurd number of assists all game (tremmors, intiatior, tank + AOE), every game. Assists = steady gold income.

#3 Rammus wil likely have a high number of kill shots while being full tank because of all the AOE going off, and his long stun and effective chase ability to pick off a runner (PB+ TAUNT is a lot of time, ok dmg). He's also superb early/mid game ganking 2v1, his Pball+ taunt sets up a nearly sure-kill with the right partner.

If you had a support champ laning with you, you may be able to get away with no regen. Short of that or some particular premade strategy, Doran's his probably the #1 thing to change his experience. And once he has sunfire, he farms quite well the rest of the game. That and being aggressive, he'll see a change in his early game.

I usually start with shirt + 5 HP pots, build HoG, boots, then defensive item based on enemy combo. I've only played Rammus 20 or so times, but the best advice I can give is similar to everyone here: lane with a ranged/harass punisher, continue to practice last-hitting, play defensively with your taunt+turrets, and don't hesitate to dump points into DBC early so that you can survive the approaches for last-hits.

Another trick I've found is using DBC, hitting 3 creeps (like the casters) once, then when they get low health, PB into them for a mini-farm.

Good luck! Rammus is awesome and a lot of fun to play, so don't give up